How
do you define a moment in time that it is so brief it could have been brushed
off, yet it was so profound it changed you forever? The patient looked into my eyes with tears
and stroked my hand in the last hour of his life. This moment is the seed that
the principles of my nursing practice have grown from. This man that did not
speak my language was taking the very last moments of his life to thank me.
Mr.
X was a patient not unlike the other chronically ill patient on our floor,
except for the fact that he was an illegal immigrant without health insurance.
Mr. X was being readmitted on a weekly basis for hemodialysis treatments. Quite
frankly, he was destroying the bottom line of the small community hospital. The
hospital did a huge fundraiser and he was given enough money to return to his
home country with his family and to start over. It was much more cost effective
than providing weekly dialysis treatments. For the patient’s own reasons he
chose not to use the donated money for this purpose.
Mr.
X’s return angered many staff members and the attending dialysis doctor. This
doctor had been a significant player in raising a large amount of the money to
start this man’s life over. The nurse
giving me report made it clear that the dialysis doctor ordered no visitors, no
pain medication, no television, nothing by mouth and enemas, every hour to
bring down potassium levels. When I asked why, she cited that it was a way of
discouraging his return to the hospital. I walked to the room and it was clear
this man was not going to make it through the night.
I
walked into Mr. X’s room he begged to see his family. Pain was written on his
face. Stepping in to advocate for this patient, was the moment that I realized
the significance that the role a nurse can play in a patient life. Nursing is more than just assisting a person
to heal. It is about creating a safe, caring environment that promotes dignity
and wellbeing through all stages of life (Selanders & Crane, 2012).
I
called the in house supervisor and was told to follow the doctor’s orders.
Calling your unit supervisor at home in the middle of the night to challenge
doctor’s orders is a terrifying experience for a new nurse. I was told by the
unit manager to let the family in. My unit supervisor arrived thirty minutes
later. The remaining ethical concerns were addressed.
That night a framework that drives my practice took root, leadership, advocacy,
and caring.
One of the key structures of my nursing practice is leadership.
The vocation of nursing itself places every nurse in a unique position to guide
others (Selanders
& Crane, 2012). The nurse is placed
in the role of a leader by the virtue of assuming the role of a nurse (Selanders
& Crane, 2012). In order for a nurse
to become effective as a leader certain qualities and skills must be matured.
Many of the skills I have obtained in the past twenty- two years as a nurse
have been acquired through the adversity faced in everyday practice. Experience
is a quality that can come with time; other virtues of leadership are more
complex.
Leaders
must possess a strong foundation and moral code in order to influence others to
follow higher aspirations. This is not possible without the leader having a
strong foundation and morals. I do not believe a person can become a resilient
or moral leader by exterior laws or agencies. All ideas thoughts and actions
are first inspired by what is inside the man. The principles that guide me in
my leadership can be found in the Bible. To obtain the wisdom necessary to make
change that is significant require a person to humbly try an entire lifetime to
be more like the person of Jesus Christ.
The leadership style that I find true to my convictions is the
servant leadership style (Green, 2002). The underlying principal of servant
leadership is the leader serves others rather than others serving the leader (Green,
2002). A servant leadership style
emerges from individuals whose principal purpose is to support others (Green,
2002). Servant leaders, support patients, colleges and other staff members from
the perspective that by helping others achieve goals and improve themselves, it
insures future leaders and creates positive enduring change (Green, 2002). The servant leadership style also is
fundamental in promoting advocacy and care for all the lives the leader
touches.
One example of servant leadership in my current practice is my
assistance in the creation of a nursing government for my hospital. The vision
of this government is nursing leadership begins at the bedside. The nurse
leader guides by example and mentoring.
There is encouragement for greater education, nursing evidence biased
research and creating a voice for the nurse at the bedside. The goal of the
leader is to mentor each individual nurse to reach their potential thus leading
to higher quality patient care.
The next key structure to my philosophy of practice is caring. The
words of Florence Nightingale wrote in 1987 that cautions the profession of
nursing to remain contemporary, knowledgeable and caring in order to remain significant, still hold true today (Selanders & Crane,
2012). The profession of nursing has established itself by providing two basic intercessions
that all humankind needs at sometime during life caring and support (Selanders
& Crane, 2012). Caring in nursing is providing therapeutic high quality
patient focus care that advocates for what is significant for that individual
patient. The caring and advocacy that
nurses provide require action, education, vision, ethics and fortitude on the
part of the nurse (Selanders & Crane, 2012).
To be
effective at the therapeutic care a nurse must believe no job is too small.
What may seem very insignificant can have a great impact on the patient and the
quality of care provided. Washing your hands prior to caring for patients, or
doing mouth care seem menial but, can have a great impact on the health and
wellbeing of the patient. My belief is the job at hand is the one God has given
to me. No matter how insignificant the enterprise is in my site it will be used
for God’s plans. I have been made to fill particular job in the world. All
those around me have been made for something just as wonderful.
The final
philosophy that guides my nursing practice is advocacy. Advocacy is the care
nurses provide in action (Selanders & Crane, 2012). The advocacy that is provided by the nursing profession
is much more then the motherly love depicted in some of the iconic images
portrayed to the public to represent nursing.
Advocacy in nursing is looking past the infirmities of a patient and
identifying the parts of strength each person’s has to begin healing. Advocacy
is helping the patient indentify what they want and guiding them in expressing
those needs. The nurses’ role in advocacy often begins with education. Nurses
help patients learn to care and speak up for themselves. They help the patient
identify strengths to overcome the challenges faced with illness. By
identifying these strengths, the patient can build skills to care for themselves.
Advocacy is what gives strength and
energy to the care the nurse provides (Selanders & Crane, 2012).
Advocacy
is one of the most rewarding parts of the nursing profession. Nothing is more
satisfying then seeing patient overcome challenges of illness. Watching a
patient being able to control their diabetes, a solider gain accesses to
available care, and an uninsured patient obtaining a primary care physician, is
what nursing is about. Advocacy is the fruits of a nurse’s work.
The
continued improvement of the profession demonstrate advocacy at its highest
form (Selanders & Crane). The only way that nursing can continue to provide
high quality, current care, is a commitment to the profession through education
and nursing research. Caring, advocacy and leadership are all very complex
interactions that the nurse engages in with patients, staff, doctors and the
community.
It
is my belief that nursing is a calling. To be successful in life, every
individual must find a way to reach beyond themselves and serve mankind
(Selanders & Crane, 2012). My nursing career is a reflection of my own
unique talents and abilities. Nursing is an inimitable profession, which allows
individuals to use both the practical scientific mind and the creative artistic
intellect (Selanders & Crane, 2012). The goal of every nurse should be to treat
every patient in a holistic manner despite income, race, religion, sex, or
beliefs and provide therapeutic patient centered care.
One
of my greatest convictions is to help the small community hospital in my
hometown thrive. Having a small district hospital that provides high quality
affordable care makes a significant difference in the lives of the community.
Having a hospital within close proximity can be lifesaving. Five minutes can
save a person having a stroke from a life time of disability or even death. The
hospital provides not only health care, but also meaningful employment to many in
the community. The patients and staff that are in my charge are mothers,
brothers, friends, church members and school teachers. These people are my
community.
There is nothing more valuable in life than
the people we love and good health. Nurses are trusted with people lives and
that should not be taken lightly. I am honored to have been trusted with
something so profound. I believe that I am responsible personally to God for
the care I provide and the leadership that I practice. With the ever increasing
complexities of health care it is going to be essential for all nurse managers
to develop leadership, advocacy and caring skills at the level of the bedside
nurse. This requires the nurse manager
to be highly engaged in the art of nursing, grounded in evidenced biased
practice, skilled at communication, collaboration and leadership. These
qualities are honed through contemplative leadership, education, research and
dedication.
References
